Editors Note: This is a guest contribution from two medical students, one from Chicago and one from Queensland. If you like their work, we’ll consider having them write more for us.
Andrey Pavlov Jr.
University of Queensland School of Medicine
Igor Irvin Bussel
Chicago Medical School
Rosalind Franklin University of Medicine and Science
In hopes of joining the SBM movement as medical students, we wanted to take aim at a topic that has yet been finely dissected a la Novella or logorrheicly dismembered a la Gorski. Having realized that a fellow medical student, Tim Kreider, is already addressing integrative medicine on campus, we decided that we would attempt to find a controversial topic that has yet to be addressed on SBM. A serendipitous question from a friend sent us on a mission to explore the pseudo-scientific underbelly of the web and science-based rationale of the claim that vitamin C can induce abortion.
The World Wide Web is a stranger place than we can ever imagine. Most users are aware that they can’t believe everything they read on the Internet, yet they often feel like Sherlock Holmes when they find an esoteric and isolated clue to their own unique health puzzle. Recently, we were asked if there was a connection between vitamin C, menstruation and abortion. We were caught off guard by the question, finding it such a strange connection to make. The story, it seems, is that our friend had come down with a cold and taken mega doses of vitamin C to stave it off (another false belief, but not the subject here). A couple of days later her menses began and she was surprised since it was 4 days earlier than normal. She of course turned to Dr. Google and was quickly provided with numerous sources indicating that indeed, vitamin C would induce the start of a menstrual cycle and can even act as a “natural” abortefacient and a substitute for the ‘morning after’ pill. Being a bit more keen than your average Dr. Google user, she was surprised and continued searching, trying to find evidence to contradict these claims. Alas, she found nothingexcept more sites parroting and corroborating the claim. Then she realized she knew a couple of medical students and asked us what we thought. Our literature review turned up a slew of websites using the standard repertoire of trite pseudo-scientific tactics. Any attempt to find a credible source, validated claim, or independent consensus proved futile.
At the time of this writing, Google yielded over 400,000 results when searching for “vitamin C abortion” and around 45,000 results when searching “ascorbic acid abortion.” While both search queries resulted in about 38 entries on PubMed, nothing was found using Up-To-Date or Cochrane Collaboration. However, regardless of query terms, we could find no sites that refuted the claim of vitamin C as an abortefacient.
The top returned website references a Russian article written in 1966 by Samborskaia and Ferdman. This site will be the focus of our piece since it appears the most legitimate having a complete “references cited” section. This gives the illusion of credible research and bears thorough debunking. Sadly, the Russian article is the most relevant and “scholarly” article. The author of the site offers this analysis to support her claim:
The article is in Russian, and finding a copy was a problem… as was the language barrier. I had been corresponding with a lady from Slovak Republic (Slovakia) and mentioned the article. She went out looking for it, and was able to find a copy. She was able to translate it for me, and noted that the author did not specify the doses of ascorbic acid administered to the women, and the author also did not say specify how the women received the ascorbic acid; ie, liquid, injection, tablet.
The scientists who conducted the research, Samborskaia and Ferdman, came to the conclusion that high doses of Ascorbic Acid appeared to increase estrogen levels which contributed to the interruption of an otherwise normal pregnancy. 20 women who approached doctors requesting an abortion participated in the study. Research was conducted by ob/gyn L.I. Ivanyuta. The women ranged from 20 to 40 years of age. The article does not say if a positive pregnancy test was obtained from the participating women. We also don’t know how much ascorbic acid the women were given. They did however measure estrogen levels before and after treatment with ascorbic acid, finding that estrogen levels were higher after taking the ascorbic acid. Of the 20 women, 16 began menstrual type bleeding within 1 to 3 days from administration of ascorbic acid.
So the evidence cited here is from an article the author could not find, in a language she could not understand, translated by some unknown woman in Slovakia, with a sample size of 20, no known dosages or methods of administration, and even an admission that there was no documentation that all 20 women were even pregnant. Already riddled with biases, flaws, and fallacies, the author continues:
Also, in my own personal research, I’ve come into contact with numerous women who did confirm their pregnancies with a test, then used ascorbic acid (sometimes in conjunction with other herbs) to terminate those pregnancies successfully… While it can’t be considered scientific data, it is none-the-less proof that these home remedies do work for some women.
That which can’t be considered scientific data can’t be asserted as proof. This is a common failing in pseudo-scientific writings – an appeal to some other form of proof or “other ways of knowing.” The author continues with the empiric discussion:
It is said that on average 1 in every 4 pregnancies end in miscarriage. This would be 25% of all pregnancies. Statistics vary somewhat, and age is a factor, some say as few as 16% up to as much as 30% of all pregnancies end in miscarriage. A government website says 50% of all fertilized eggs die or are lost spontaneously – usually prior to the woman knowing she is pregnant, many of which do not implant in the uterine wall. In known pregnancies, they say that about 10% miscarry naturally and this normally happens between the 7th and 12th week of pregnancy. With this in mind, observations from my own research and data collection, about 45% of women with confirmed pregnancies are successful when using vitamin c (ascorbic acid) with the intention to end a pregnancy at home. This is well above the estimated rate of natural miscarriages (non-induced), so even if some of these women would of miscarried on their own without the steps they took to induce miscarriage at home (10% of known pregnancies miscarrying naturally or 1 in 4 pregnancies (known or unknown) ending naturally) these figures do not account for the increased rate of spontaneous abortion that I’m seeing through the data these women voluntarily provide.
The author cites a wide range of data on spontaneous abortion rates and concludes that “up to 30%” of all pregnancies end in miscarriage, though “a government website says 50% of all fertilized eggs die or are lost spontaneously”. From her own personal anecdotal “data” she finds that “45% of women with confirmed pregnancies are successful when using vitamin C… with the intention to end pregnancy at home.” For her, this is “well above” the estimated rate of “natural miscarriages” and therefore evidence that vitamin C works for this purpose. She further states that if the attempted vitamin C abortion does not work, it is important to go ahead and obtain a clinical abortion since even though the USDA does not list vitamin C as teratogenic, such a mega dose in an embryo has “too many unknowns” and one should not risk “having a messed up kid.” How can we ignore such sage medical advice and dutiful statistical analyses?
At least she can admit that “[n]atural or do-it-yourself does NOT mean it is SAFE [her emphasis].” That is about the only redeeming part to this travesty of medical advice. However, even the author’s own “statistics” indicate that, at best, there is only a very slight increase in the rate of abortion with vitamin C over spontaneous miscarriage. Considering the very small sample size, poor data quality, and complete lack of rigor it is safe to say this is either just completely false or normal noise with no statistical significance at all – not that we could even run a statistical analysis with the “data” we are given. Once again, the common pseudo-science tactic of asserting a statistical conclusion with no actual analysis rears its head.
Although we focus here on only one site devoted to this “naturalistic” nostrum, the remaining sites we found either reference this one, the original Russian article, or simply parrot the same piffle with no references at all. For example, NaturalMiscarriage.org has similar preposterous claims to the efficacy of many herbal abortefacients, including vitamin C, and even claims that in their respondent survey that 171 of 235 women (73%) who tried vitamin C had successful miscarriages. A few lines down we find that 93 of 118 women (79%) who tried “visualization and prayer” had a successful miscarriage. And apparently 38 of 46 women (83%) who tried avocados had a successful miscarriage – so we should clearly suggest avoiding guacamole at your church social if you are pregnant.
This pseudo-scientific claim has already failed from an evidence-based medicine perspective, but how about throwing a little science in the mix and conjecturing a prior probability? From the only article cited as reference to a human population, the mechanism is described as both “elevating estrogen levels to interrupt a normal pregnancy” and the “acid” of ascorbic acid (vitamin C) acting to disrupt the endometrium directly leading to the sloughing of menses. A quick PubMed search reveals four articles relating in at least some way to “vitamin C and abortion” in humans. One is a 2005 Cochrane review that examines multi-vitamin prenatal treatment as a prevention of miscarriage and stillbirth (not specifically vitamin C) and finds no relation between miscarriage and prenatal vitamin consumption. A 2011 update to the review holds the same conclusions. Two have no article or abstract available (one is in Polish from 1987 and the other in the Lancet from 1974). The last one is also a very small study (n=50) and found no causal relationship between vitamin C and spontaneous abortion. Furthermore, any biology undergraduate who passed physiology would know it is the drop in hormonal levels (including estrogen) that triggers the start of menses. Additionally, from a simple physiological point of view, the notion that ingesting a large amount of “acid” can alter the pH balance of the endometrium significantly enough for a physiological response is ludicrous. There is no mechanism by which vitamin C would be preferentially localized to the uterine wall and if the blood pH was changed enough to cause an endometrial sloughing, late menses would be the last of your worries.
In today’s political climate in America, especially in light of the recent vote to remove the federal funding for Planned Parenthood, having access to accurate medical advice based in science is important, regardless of your personal stance on the issue. Notably, based on a 2011 study in the American Journal of Obstetrics and Gynecology, 1.4% of 9,493 women surveyed, reported using vitamin C or herbal products to attempt to end a pregnancy. Though this is not an urgent danger to public health, others on the web have snagged onto this idea and have begun posting this same advice on forums such as eHow and women are actually seeking advice since these authors give the impression of authority on the matter. The startling thing is that there are simply no sources out there that say anything else about vitamin C and abortion – every searched source claimed efficacy of the method. The echo chamber of the Internet repeats the original assertion without any information to the contrary. For a person like our friend, there is little recourse except to assume that there must be some truth to this farcical claim. She had us to ask and it is our hope that this piece will give others a credible source to refute the claim that vitamin C induced abortion is legitimate.